Shaper for vertebral fixation rods

ABSTRACT

A system for rod bending for use in robotic spinal surgery, enabling the correct bending of a fusion rod to match the shape required to accurately pass through the heads of the pedicle screws. The system uses data generated by information provided to the robot by the surgeon&#39;s preoperative plan, optionally augmented by feedback from the robot control system of deviations encountered intraoperatively. Such deviations could occur, for example, when the surgeon decides intraoperatively on a different trajectory or even to skip screws on one vertebra, in which case, the robot will be commanded to perform the alternative procedure, with commensurate instructions relayed to the control system of the rod-bending machine. The system is also able to thin down the rod at predetermined locations along its length, adapted to be at selected intervertebral locations, for maintaining limited flexibility between vertebrae, instead of fixating them.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a national stage application under 35 U.S.C. § 371of PCT application Ser. No. PCT/IL2015/051182, having an internationalfiling date of Dec. 4, 2015, which designated the U.S., and whichclaimed the benefits of and priority under 35 U.S.C. § 119(e) to U.S.Provisional application Ser. No. 62/087,314, filed on Dec. 4, 2014,entitled “Shaper for Vertebral Fixation Rods.”

FIELD OF THE INVENTION

The present invention relates to the field of the shaping of rods usedfor the fixation of vertebrae in spinal fusion treatment, and their usein robotically directed surgery, especially shaping performed usinginformation obtained from pre-operatively generated images of thesurgical site and intraoperative updates.

BACKGROUND OF THE INVENTION

When performing surgery to insert vertebral fixation rods for spinalfusion, there is a need to ensure that the fusion rod is passedaccurately between the tulips of the pedicle screws, before the screwsare tightened onto the rod. This can be a problematic task since thespine may be severely deformed in a scoliotic patient, and even in anon-scoliotic patient, adjacent vertebrae generally have differingprotrusion heights and are not linearly aligned because of the naturalspinal lordosis. Reference is made to FIG. 1 which illustrates such atypical vertebral fixation rod implementation, in which the rod 11 hadbeen given a curvature to match the lordosis curvature of the spine 10.In currently used procedures, the surgeon generally bends the fusion rodduring the operation, typically using manual tools, so that it matchesthe positions of the tulips 12 of the pedicle screws, using his/hervisual judgment in order to ensure that the rod fits accurately betweenthe heads 12 of the various screws. However this procedure is prone toinaccuracies and since a typical fusion rod is intended to be a highstrength component and is generally made of titanium or stainless steeland is typically 5 mm in diameter, the surgeon often has to exertconsiderable force using pliers to bend the rod appropriately duringconnection, in order to ensure that the rod fits without exerting unduepressure on the patient's vertebrae.

In US Patent Application Publication No. 2005/0262911 to H. Dankowicz etal, for “Computer Aided Three-Dimensional Bending of Spinal RodImplants, other Surgical Implants and other Articles, Systems forThree-Dimensional Shaping, and Apparatuses Therefore”, there isdescribed a computer aided system for bending an implantable rodthree-dimensionally, which is especially useful for pre-surgicalformation of implantable spinal rods. Such a system may also use imagingperformed intraoperatively on the surgical site, especially to determinethe position of pedicle screw heads (tulips) to which the rod is to beattached, in order to determine the shape of the rod to be formed.However, in order to perform intra-operative bending of the rod to matchthe desired shape in 3D, this system requires the generation ofadditional images during the procedure, which subjects the patient andpossible also the medical staff, to additional radiation exposure.

Therefore, there is a need for an apparatus and procedure which willenable the surgeon to accurately and easily shape a vertebral fixationrod during the surgical procedure, without the need for additionalimaging to determine the shape the rod has to be given.

Additionally, although such rod assemblies may be used to fuse twoadjacent vertebrae, there are often cases of scoliosis and severedeformities where the region of the spine to be treated may include even10 or more vertebrae. Such a long construction may be used to rigidlyconnect all the vertebrae within the desired range, but in certain casesthere is no need to fuse all the levels and some vertebra should not befused together in order to preserve their relative motion. Hence thereis also a need for a rod that poses different compliances at differentpoints in accordance with the fusion or dynamic stability needs of thespine.

There therefore exists a need for such devices and methods whichovercomes at least some of the disadvantages of prior art systems andmethods.

The disclosures of each of the publications mentioned in this sectionand in other sections of the specification, are hereby incorporated byreference, each in its entirety.

SUMMARY

The present disclosure describes new exemplary systems for rod bendingfor specific use in robotic spinal surgery, which enables the productionon site in the operating room of a fusion rod correctly bent to matchthe shape required to accurately pass through the tulips on the heads ofthe pedicle screws, using data generated by the positional informationprovided to the robot by the surgeon's preoperative plan, augmented ifnecessary by data feedback provided by the robot control system of anydeviations encountered intraoperatively in execution of the surgeon'spreoperative plan. In a typical robotic spinal surgical procedure, thesurgeon's preoperative plan is generally based on images of thepatient's spine generated preoperatively, on the basis of which thesurgeon plans exactly where the pedicle screws are to be inserted, atwhat orientation and to what depth. The surgical robotic system can thendirect the robot in all three dimensions such that the drilling positionand orientation is adapted to enable the screw hole to be drilledexactly in the position and orientation determined by the surgeon'spreoperative plan. Furthermore the three-dimensional nature of thepreoperative plan also enables the determination of the extent ofprotrusion of each screw in the AP direction relative to the patient'sspine. In those robotic systems where the drilling itself is performedby a robotic tool, the feedback provided by the robot control systemduring the drilling operation can provide additional data regarding theextent of any deviation from the surgeon's preoperative plan. This couldoccur for example when the surgeon decides intraoperatively on adifferent trajectory or even to skip screws on one vertebra, in whichcase, the robot will be commanded to perform this alternative procedure,and these instructions will therefore also be relayed to the controlsystem of the rod-bending machine.

The data stored in the robotic control memory includes informationregarding the exact position of the pedicle screw heads, both in thelateral and AP directions. This coordinate information can thus be usedin a rod bending apparatus, using for instance controlled plungers, todeform the rod in the directions required, such that it matches thecoordinate set required by the positions of the heads of the pediclescrews. The plungers can most conveniently be motorized, though otherdrive methods may also be used, and should be equipped with an encodingmechanism for defining their position. Alternatively, the informationregarding the extent of bending required could be obtained by imageprocessing of X-ray images obtained of the spine of the patient afterthe pedicle screws have been inserted. The output of this imageprocessing procedure could be the set of coordinates in three dimensionsthrough which the rod passes through. Alternative bending machineconfigurations can also be used.

If the procedure is being performed using a navigation or a trackingsystem to define the position and orientation of the pedicle screwplacements, an alternative source for the input data regarding theposition of the pedicle screw heads could be provided by the navigationor tracking system itself. This data could be provided either by meansof a touch probe which is directed onto the pedicle screw heads, or bymeans of position emitters fitted directly on the surgical tool or itstool guide. The control system of such a system is able to transfer thepositional data directly to the control system of the rod bendingequipment, to ensure that the desired shape of the rod is generated.

Additionally, the rod bending apparatus could also be equipped with afacility for thinning down the rod at predetermined locations along itslength, at which locations it is desired to maintain a level offlexibility between vertebrae, instead of fixating them.

There is thus provided in accordance with an exemplary implementation ofthe devices described in this disclosure, a method for shaping anintervertebral connection rod for use in a computer assisted spinalstabilization procedure, the method comprising:

(i) providing a surgical plan based on preoperative images of apatient's spine, the plan defining the position and orientation ofpedicle screws whose insertion into the patient's vertebrae is toperformed with the assistance of either a robotic system or a navigationsystem,

(ii) generating from the robotic or navigation system, positional dataincorporating the coordinates of the points at which the rod sitscorrectly in each desired pedicle screw head,

(iii) inputting the positional data to the control system of a rodshaping system, the system adapted to use the positional data to bend arod inserted therein, such that it adopts a shape that will sitcorrectly in the desired pedicle screw heads, and

(iv) actuating the system to generate a correctly shaped rod for use inthe spinal stabilization procedure.

In such a method, the robotic system may be adapted to insert thepedicle screws, and the method may further comprise the step ofadjusting the positional data according to any deviation from thepreoperative surgical plan of the final position of the pedicle screwinsertion, as determined by the robot system.

According to a further implementation of the above described methodswhich use a navigation system, the navigation system is used to definethe position of the pedicle screw heads by means of a touch probe.Alternatively, the navigation system may be used to define the positionof the pedicle screw heads by means of reference markers either on thepedicle screw heads, or on a surgical tool adapted to drill a vertebralhole.

In any of the above described methods, the rod-shaping system maycomprise a plurality of plunger pistons disposed laterally to a cavityin which the rod is clamped, and wherein the positional data is used tomove the plunger pistons such that they bend the rod to a shape inaccordance with the positional data. Such a method may furthercompromise the rotation of the rod, such that the plurality of plungerpistons can shape the rod in three dimensions. Alternatively, theplurality of pistons may be arranged in more than one plane such thatthe rod can be shaped in three dimensions without being rotated in thecavity.

According to yet another implementation of the above described methods,the rod shaping system may further comprise a rod thinning module,adapted to reduce the cross-sectional area of the rod at predeterminedlocations, such that the rod has increased flexibility at thepredetermined locations. In such an implementation, the rod thinningmodule should be able to adapt the cross sectional dimension of the rodin different planes according to clinical need. In either of thesecases, the rod thinning module may reduce the cross sectional dimensionof the rod by means of indentations generated in the rod at thepredetermined locations. In that method, the indentations may begenerated by appropriately shaped plunger pistons.

As an alternative to the use of plunger pistons, the rod thinning modulemay reduce the diameter of the rod by means of mechanical removal ofmaterial from the rod at the predetermined locations. That mechanicalremoval of material may be performed by a controlled milling action.

Additionally, alternative implementations of methods for generating anintervertebral connection rod for use in a dynamic spinal stabilizationprocedure in a subject, may further involve:

(i) providing a surgical plan of a patient's spine, the plan definingthe desired shape of the intervertebral connection rod in threedimensions, and defining vertebrae between which dynamic mutual motionis to be maintained,

(ii) using a rod shaping system to generate the intervertebralconnection rod having the desired shape defined by the surgical plan,and

(iii) using the rod-shaping system to reduce the cross-sectional area ofthe rod at rod locations corresponding to regions falling between thevertebrae when the rod is attached to the subject, such that the rod hasincreased flexibility at the regions.

In such a method, the surgical plan may be based on preoperative imagesof the subject.

Still other example implementations involve a system for generating anintervertebral connection rod for use in a dynamic spinal stabilizationprocedure in a subject, the system comprising:

(i) clamps for holding the rod in the system,

(ii) a bending mechanism for applying predetermined bends to the rod atpreselected longitudinal and azimuthal positions such that the rod isshaped in accordance with a surgical plan, and

(iii) at least one rod thinning element disposed such that the crosssection of the rod can be reduced at predetermined locations along thelength of the rod.

In such a system, the bending mechanism may comprise a set of adjustablerod-bending elements, disposed in positions that enable the elements toapply predetermined bends to the rod at preselected longitudinal andazimuthal positions such that the rod is shaped in accordance with asurgical plan. Alternatively, the bending mechanism may comprise arotatable chuck for gripping the rod, and a controlled bending mandreladapted to apply a lateral force on the rod at a point distanced fromthe chuck. In any such systems, the surgical plan may be based onpreoperative images of the subject.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated more fully fromthe following detailed description, taken in conjunction with thedrawings in which:

FIG. 1 illustrates a typical vertebral fixation rod implementation, inwhich the rod had been given a curvature to match the lordosis curvatureof the spine;

FIG. 2A illustrates schematically a plan view of a rod shapingapparatus, using mechanical plungers or pistons for bending the rod, andFIG. 2B shows a prior art press bending rod shaping apparatus;

FIG. 3 illustrates how the robot control provides inputs to the plungercontrol of the rod shaping apparatus of FIG. 2A, so that the rod isshaped to the desired form; and

FIG. 4 illustrates a thinning operation being performed using theapparatus shown in FIG. 2A with a pair of oppositely disposed pistonplungers.

DETAILED DESCRIPTION

Reference is now made to FIG. 2A, which illustrates schematically a planview of a rod shaping apparatus 20, using mechanical plungers or pistons21 for shaping the rod. The rod 23 is firmly held in end clamps 22,which may be rotatable to enable three-dimensional bent shapes to beexecuted. The plungers or pistons 21 may be driven by hydraulic orpneumatic cylinders, or by electric motors (none of which are shown inFIG. 2A), or by any other motion impartation device that can providesufficient force to bend the rod as required. In the exemplary apparatusshown in FIG. 2A, the rod-bending process in the plane shown isperformed by sets of plungers or pistons, arranged opposite to eachother, such that good control is achieved of the bending process, andthe bending can be achieved in either direction of concavity. However,it is to be understood that a bend in any direction can also be achievedby having the plunger or piston oriented only at the intended concaveside of the bend to be produced, and by applying force to the rod fromthat direction only.

In order to achieve a three-dimensionally shaped rod, as will berequired when the patient has any significant extent of scolioticdeformation to add to the natural lordosis curvature, the end clamps 22may be constructed to be rotatable, and the bends applied in theappropriate plane by the plungers or pistons as the rod is rotated toeach appropriate azimuthal angle. Alternatively, a static rod clamp maybe used, in which case sets of plungers or pistons are disposed atdifferent azimuthal angles about the axis of the rod, such that thethree dimensional shape can be generated with the rod clampedstatically.

Reference is now made to FIG. 2B, which illustrates schematically a planview of another typical rod shaping apparatus, which may also be used inthe implementation of the methods and systems of the present disclosure.Such a bending machine configurations have been known for a long time,and one such example is shown in the above referenced US patentApplication Publication No. 2005/0262911. In FIG. 2B, the rod 23 is heldin a rotatable clamping chuck 24, mounted on a sliding block base 26,which can move the rod longitudinally along the linear machine base 25.The bending process takes place by applying pressure, such as by meansof a hydraulic cylinder 27, to a push die 28, which forces the tube 23to bend around the forming die 29, which has a radiused contact face toform a smooth curve. The position in the rod of the bend or bends iscontrolled by the longitudinal position of the sliding base block.Rotation of the rod in the rotatable chuck 24 enables a rod to be formedwith three-dimensional curves.

Reference is now made to FIG. 3 which illustrates how the robot controlprovides inputs to the plunger control 33 of the rod shaping apparatus,so that the rod is shaped to the desired form. The surgical procedure ofdefining the position and orientation of the pedicle screws and theirassociated connection rods is generally performed by the surgeon in asurgical plan 30 generally obtained on the basis of preoperative threedimensional image sets, such as CT or MRI images of the region ofinterest. The surgical plan is used to define the robot pose to beadopted for the drilling of each pedicle screw hole. In some cases, thecontrol system also supervises the drilling operation to form the holeand to screw in the pedicle screws to the required maximum torque toensure firm insertion. The required information is extracted from thesurgical plan 30 and is input to the robot control system 31, toinstruct the robot 32 to perform the desired motions to align thesurgical tool as required for the process to be performed on thesubject's vertebrae 39, such as the drilling of holes for pediclescrews. In addition to providing instructions to activate the roboticmotion, the robot controller 31, or an additional control module forextracting co-ordinate information from the surgical plan, inputslocation information to the rod shaping apparatus control module 33. Aninformation bus 37 conveys this information, advantageously in the formof a set of motions which each of the shaping pistons or plungers 34must perform, to servo-controlled actuators 35 to move the plungers orpistons in order to bend the rod (not shown) clamped in the rod shapingapparatus 33 to the desired shape. In addition, in those implementationswhere the rod is also rotated to provide three-dimensional shaping,commands are also conveyed through the control bus 37 to the rodrotation servo motor or motors 36. By this means, the rod shaping systemis able to automatically produce a fixation rod, correctly bent to theshape required for use according to the initial surgical plan 30,without the need for the surgeon to perform any manual operations on therod during the surgery, in order to adapt it to match the exactpositions of the pedicle screw heads.

FIG. 3 shows the implementation of the methods of the present disclosureon a rod-shaping machine having plunger bending action, such as that ofFIG. 2A, but it is to be understood that these methods can also beapplied to any other sort of controllable bending machine, such as thatshown in FIG. 2B, with the appropriate commands output from the shapingcontroller 33 being directed at the longitudinal motion drive, thebending die position actuator, and the rotational position of theclamping chuck.

Furthermore, in installations where the robot also performs controlledinsertion of the pedicle screws, a feedback signal from the robotdefining the exact position into which each pedicle screw was inserted,can be used to input further information to the shaper controller, forproviding any corrections needed to the bending profile, for instance,in the event that the physiological conditions of the bone were suchthat the pedicle screws were not inserted to the insertion levelrequested by the surgical plan, or in the event that the surgeon makeschanges intraoperatively to the plan, as mentioned hereinabove. Inaddition, there is shown in FIG. 3 an additional and alternative input38 to the shaper controller from a navigation or a tracking system (notshown).

The above description is applicable to situations where fusion is to beapplied to all of the desired section of the patient's spine. Howeverthere are many situations in which, because parts of the spinal regionbeing treated may clinically be preferred to have a level of naturalflexibility, fusion is not required between all of the adjacentvertebrae of the patient's spine. However, instead of using separatesections of fusion rods excluding those vertebrae sections where fusionmay not be required, it may be simpler and more advantageous to use asingle rod (generally one on each side of the spine) in order to coverthe entire section of the spine to be treated. Moreover, in order toachieve dynamic spinal stabilization between some vertebrae, somerigidity of the rod may be needed between those vertebrae, and thiswould be missing if two separate sections of rods were to be used. Insuch situations, some sections of the rod structure have to remain moreflexible, such as in locations where the disc is still functional, whileother sections of the rod have to maintain their stiffness to assist inproviding complete fusion. In order to achieve this structure, at thoselocations of the patient's spine where some flexibility is desired, therods can then be provided with thinned sections between the pediclescrew locations. The thinning of the rod can be achieved either byshaving or machining off some of the material of the rod in the regionwhere increased flexibility is desired, or by using the same plungers togenerate one or more dimples in the surface of the rod to reduce itsthickness, and hence to increase its compliance, at that point. This canbe achieved by actuating two opposing plungers operating against eachother to thin the rod down in the space between the plungers. Thisthinning process may be applied either to a pair of rods on either sideof the spine, or on a single rod positioned on one side of the spine.The latter procedure is often used in minimally invasive cases, wherethe use of one rod minimizes the number of skin incisions. Also, if agiven compliance between non-fused vertebra is to be maintained indynamic stabilization, then only one rod with variable rigidity may bepreferable.

Instead of plunger generated thinned segments, a miniature controlledmilling cutter (not shown) can alternatively be applied to the rod atthe relevant positions either to reduce the diameter of the rod, thusincrease its flexibility in all orientations, or to generate anasymmetric radial dimension to increase flexibility in a predeterminedradial direction, as now explained.

The flexibility is generally applied isotropically, by thinning down therod uniformly in essentially all azimuthal angles. However, there may bepathological situations in which flexibility is to be maintained in oneparticular plane of the spine, while rigidity is required another plane.This can be achieved by aligning the direction of the flexibility tomatch what is desired by the physiological situation of the patient'sspine. This can be performed by changing the Moment of Inertia (MOI) ofthe rod in one plane relative to its orthogonal plane, by applying thethinned out section in one azimuthal plane relative to the rod's axis,but not in the other plane. The desired plane can be selected either byuse of a rod shaping system having pistons or plungers aligned at anumber of azimuthal angles around the rod and by applying the plungersappropriately, or by rotating the rod so that a single or a pair ofoppositely located shaping plungers at a fixed azimuthal angle arealigned in the plane where the flexibility is to be applied.Alternatively, a miniature controlled milling cutter can be applied tothe rod at the relevant positions and at the relevant azimuthal angles.

Reference is now made to FIG. 4 which illustrates one example of howsuch a thinning operation can be performed using the apparatus shown inFIG. 2A. The exemplary implementation shown in FIG. 4 uses a pair ofoppositely disposed piston plungers 41 with mushroom shaped heads whichgenerate indentations 42 on diametrically opposite points of the rod'ssurface. The indentations essentially thin the rod down. Alternatively,the above mentioned miniature milling cutter could equally well be used.In the case of classic die bending operations, such as in FIG. 2B, themechanical miniature milling cutter can be positioned at any suitableposition along the longitudinal length of the machine. In all cases ofthinning, care must be taken not to weaken the rod to a point at whichthere is danger that it will break due to material fatigue.

Although the above described system has been described with reference tothe generation of correctly bent fixation rods for use in spinal fusionusing pedicle screw attachment, it is to be understood that the systemsare not limited to this particular application, but can be used forbending and shaping orthopedic inserts where the shaping is performedintraoperatively, and where the shape is generally predefined by meansof an image-generated preoperative surgical plan.

It is appreciated by persons skilled in the art that the presentinvention is not limited by what has been particularly shown anddescribed hereinabove. Rather the scope of the present inventionincludes both combinations and subcombinations of various featuresdescribed hereinabove as well as variations and modifications theretowhich would occur to a person of skill in the art upon reading the abovedescription and which are not in the prior art.

We claim:
 1. A method for shaping an intervertebral connection rod for use in a computer assisted spinal stabilization procedure, comprising: receiving, at a controller of a robotic rod-shaping system, location information based on preoperative images of a patient's vertebrae, the location information about a position and orientation of a plurality of pedicle screws to be inserted into the patient's vertebrae using a robotic system, each of the plurality of pedicle screws comprising a pedicle screw head attachable to an intervertebral connection rod; generating, from the location information, positional data corresponding to coordinates of an expected position of each pedicle screw head; and causing a rod-shaping device of the robotic rod-shaping system to bend the rod, based on the positional data, such that the rod is shaped to extend through the coordinates of the expected position of each pedicle screw head.
 2. The method of claim 1, further comprising: receiving, at the controller of the robotic rod-shaping system, second location information corresponding to an installed position and orientation of each of the plurality of pedicle screws; and adjusting the positional data based on the second location information.
 3. The method of claim 1, wherein the step of causing the rod-shaping device of the robotic rod-shaping system to bend the rod further comprises causing a plurality of plunger pistons of the rod-shaping device, the plurality of plunger pistons disposed laterally to a cavity in which the rod is clamped, to bend the rod based on the positional data.
 4. The method of claim 3, further comprising: rotating the rod such that the plurality of plunger pistons can bend the rod in three dimensions.
 5. The method of claim 3, wherein the step of causing the plurality of plunger pistons of the rod-shaping device to bend the rod based on the positional data further comprises causing the plurality of plunger pistons of the rod-shaping device, the plurality of plunger pistons arranged in more than one plane, to bend the rod in three dimensions without rotating the rod in the cavity.
 6. The method of claim 1, wherein the robotic rod-shaping system further comprises a rod thinning module, the method further comprising: using the rod thinning module to reduce a cross-sectional area of the rod at one or more predetermined locations, such that the rod has increased flexibility at the one or more predetermined locations.
 7. The method of claim 6, wherein the step of using the rod thinning module to reduce the cross-sectional area of the rod at the one or more predetermined locations further comprises using the rod thinning module to change a cross-sectional dimension of the rod in each of a plurality of different planes.
 8. The method of claim 6, wherein the step of using the rod thinning module to reduce the cross-sectional area of the rod at the one or more predetermined locations further comprises using the rod thinning module to reduce the cross-sectional area of the rod by indenting the rod at the one or more predetermined locations.
 9. The method of claim 8, wherein the step of using the rod thinning module to reduce the cross-sectional area of the rod by indenting the rod at the one or more predetermined locations further comprises generating indentations by appropriately shaped plunger pistons.
 10. The method of claim 6, wherein the step of using the rod thinning module to reduce the cross-sectional area of the rod at the one or more predetermined locations further comprises using the rod thinning module to reduce a diameter of the rod by mechanically removing material from the rod at the one or more predetermined locations.
 11. The method of claim 10, wherein the step of using the rod thinning module to reduce the diameter of the rod by mechanically removing material from the rod at the one or more predetermined locations further comprises mechanically removing the material by a controlled milling action.
 12. A system for shaping an intervertebral connection rod for use in a dynamic spinal stabilization procedure in a subject, the system comprising: a housing comprising a first end, a second end opposite the first end, and a first side extending from the first end to the second end; a pair of rotatable chucks for holding an intervertebral connection rod, one of the pair of rotatable chucks mounted to the first end and another of the pair of rotatable chucks mounted to the second end, the pair of rotatable chucks sharing an axis; a bending mechanism comprising a plurality of adjustable plunger elements, each of the plurality of adjustable plunger elements mounted to the first side, each of the plurality of adjustable plunger elements oriented perpendicular to the axis and extendable to contact and apply a lateral force to a rod held by the pair of rotatable chucks at preselected longitudinal positions along the rod, so as to bend the rod; and at least one rod thinning plunger element comprising a mandrel, the at least one rod thinning plunger element mounted to the first side and extendable to contact, with the mandrel, a rod held by the pair of rotatable chucks, so as to generate an indentation on a surface of the rod such that a cross-sectional area of the rod can be reduced at one or more predetermined locations along a length of the rod.
 13. The system of claim 12, further comprising: a controller that uses a surgical plan to define an expected position and orientation of each of a plurality of pedicle screws to be inserted into a subject's vertebrae, each of the plurality of pedicle screws comprising a pedicle screw head, wherein the controller actuates the bending mechanism to bend the rod so that the rod may be attached to each pedicle screw head without further bending, and actuates the rod thinning plunger element to reduce the cross-sectional area of the rod at the one or more predetermined locations, and wherein each of the one or more predetermined locations is between adjacent ones of the plurality of pedicle screws.
 14. The system of claim 12, wherein the at least one rod thinning plunger element comprises a pair of oppositely disposed rod thinning plunger elements actuatable to generate indentations on diametrically opposite points of a surface of a rod held by the rotatable chucks.
 15. A system for shaping an intervertebral connection rod for use in a computer assisted spinal stabilization procedure, comprising: a rod-shaping device, comprising a housing comprising a first end, a second end opposite the first end, a first side extending between the first end and the second end; a pair of chucks for gripping an intervertebral connection rod, one of the pair of chucks disposed at the first end and another of the pair of chucks disposed at the second end, the pair of chucks aligned on a common axis; and a plurality of controlled adjustable plunger elements, each of the plurality of controlled adjustable plunger elements secured to the first side and extendable to apply a lateral force to a rod gripped by the chucks at preselected longitudinal positions along the rod, thereby generating predetermined bends in the rod; and a control system configured to: receive location information based on preoperative images of a subject's vertebrae, about a planned position and orientation of a plurality of pedicle screws to be inserted into a subject's vertebrae by a robotic system, each pedicle screw comprising a pedicle screw head; generate, from the location information, positional data comprising co-ordinates of points corresponding to a planned location of each pedicle screw head; and cause the rod-shaping device to bend a rod gripped by the pair of chucks, based on the positional data.
 16. The system of claim 15, wherein the control system uses the positional data to selectively cause the plunger elements to move such that they bend the rod.
 17. The system of claim 15, wherein the chucks are rotatable, the rotatable chucks enabling rotation of the rod so that the plurality of plunger elements can shape the rod in three dimensions.
 18. The system of claim 15, wherein the plurality of plunger elements is arranged in more than one plane, such that the rod can be shaped in three dimensions without being rotated within the housing.
 19. The system of claim 15, further comprising a rod thinning device for reducing a cross-sectional area of the rod by indenting the rod at one or more predetermined locations, such that the rod has increased flexibility at the one or more predetermined locations, the rod thinning device comprising a first plunger mounted to the first side surface and a second plunger mounted to the second side surface opposite the first plunger, the first and second plungers extendable to contact and indent the rod.
 20. The system of claim 15, further comprising: a rod thinning device for reducing a cross-sectional area of the rod by material removal from the rod at one or more predetermined locations, such that the rod has increased flexibility at the one or more predetermined locations, the rod thinning device comprising: a material removal milling device mounted to the first side surface and operable to remove material from the rod. 